Teeth are an unlikely place to start when judging a health system, but they can be one of the most revealing.
Author
- Vikram Niranjan
Associate Professor in Public Health at University of Limerick, University of Limerick
Oral health tells a surprisingly big story. Tooth decay, gum disease and tooth loss are some of the most common chronic conditions anywhere in the world, and they often reflect how seriously a health system takes prevention.
As a dentist and researcher, this is the part that always stays with me: oral disease is rarely about one bad tooth. It is usually about the system around that tooth. What is prevented early? What is picked up late? And who can get care without delay? That makes England and Denmark an interesting comparison. Both are wealthy European countries with strong welfare traditions, but their dental systems work in very different ways.
Health Gap / Sundhedskløften is a collaborative series from The Conversation UK and Denmark’s Videnskab.dk exploring what the two countries can learn from each other when it comes to health and wellbeing.
From cycling and alcohol to inequality, healthcare and everyday habits, the series looks beyond hospitals and medical treatment to explore how culture, politics and society shape the way people live – and how healthy they are.
Children’s teeth
Denmark has built a system that public health researchers regularly point to as a benchmark. Children receive free, municipally organised dental care, with regular check-ups, fluoride use and school-based oral health support built into the system from an early age.
Dental disease starts early, so preventing it in childhood can protect teeth into the teenage years and beyond. In Denmark, oral care focuses on spotting and treating problems early, rather than waiting until they become serious.
The picture in England is very different. The latest national survey shows that 27% of five-year-olds have tooth decay, with children in the most deprived areas being far more likely to have tooth decay than those in the least deprived areas. Tooth decay is one of the leading reasons for hospital admission among young children in England.
That is one of the sharpest differences between the two countries. Denmark tries to stop the problem early. England still has too many children ending up in the dentist’s chair – or, worse, in hospital – because the problem was picked up too late.
Adult teeth
The contrast continues in adulthood. In Denmark, regular dental attendance is common, especially among older adults, and long-running surveys suggest that many people continue to see a dentist as a routine part of caring for their overall health. This is important because years of missed check-ups can add up to gum disease, tooth loss and more complicated treatment later on.
In England, access is more uneven. NHS data suggests that only around 65% of adults were seen by an NHS dentist within a two-year period. That does not mean 35% of adults have no care at all. Some of those adults go privately, but the figure still shows how difficult NHS access has become for many people. It is the difference between a system built around regular invitations to attend, and one where getting an appointment at all can feel uncertain.
The result is frustration, alongside a slow drift towards worse oral health for people who are least able to keep paying privately or chasing appointments. Oral disease is shaped by social conditions as well as biology, so those who face the greatest financial and practical barriers are often at greatest risk.
What the system rewards
One of the most useful lessons from the England-Denmark comparison is that dental systems do exactly what they are set up to do.
Denmark combines publicly funded care for children with a subsidised adult system that encourages ongoing visits, continuity and prevention. The design makes regular care feel normal. It is not perfect, but it is built around keeping people well for longer.
The system in England has a different shape. NHS dentistry is still meant to be universal, but the way it is paid for has often been seen as rewarding completed courses of treatment more than prevention. The NHS Dental Recovery Plan was meant to improve access after the pandemic and support recovery, but the wider picture remains one of pressure , uneven access and too many practices unable to take on new NHS patients.
The two systems have different incentives, and those incentives shape how care is delivered. And in healthcare, incentives matter.
Fluoride and prevention
Fluoride offers a simple example of how prevention can work in different ways.
In England, about 10% of people have fluoridated water , and the evidence shows that fluoridation can reduce tooth decay in children. But coverage is uneven.
Denmark does not fluoridate water. Instead, it relies on fluoride toothpaste, professional application (such as applying a concentrated fluoride varnish directly to a child’s teeth) and routine preventive care. The more useful lesson is how fluoride works when it is part of a system that reaches people early and consistently.
Oral disease also carries a large economic cost , so how and when money is spent is important. Spending needs to be timed well and aimed at prevention.
Denmark invests early, especially in children. The UK spends significant sums too , but more of the burden is pushed into late treatment, avoidable extractions and the costs that come with missed prevention.
Teeth turn out to be a useful measure of how a health system thinks: whether it treats prevention as optional, and whether access is something people can rely on.
That is why the England versus Denmark comparison is unique. The two systems approach prevention differently. Denmark puts more emphasis on catching problems early, while England is often left dealing with problems once they have become more serious.
This article breaks slightly with the series and compares England with Denmark. Dental policy and data collection are devolved across the four UK nations, and their oral-health surveys use different methods and population groups. England is therefore used here to provide the clearest like-for-like comparison with available Danish data.
This series was commissioned as part of a partnership between Videnskab.dk and The Conversation, where articles are published in English and Danish.
